What – Type – of RA Do You Have? #types #of


#

What Type of RA Do You Have?

Not too many years ago, a diagnosis of rheumatoid arthritis (RA) was just that a diagnosis of rheumatoid arthritis. And if you received that diagnosis, your treatment was pretty much the same as anyone else who received it large doses of aspirin followed by a corticosteroid and/or disease-modifying drugs such as gold or sulfasalazine.

Just as treatment has changed through the years, so has the thinking about RA in some cases. Rather than a single disease with a one-size-fits-all treatment strategy, some researchers believe that rheumatoid arthritis may actually be a collection of diseases. Genetic differences in individuals, they say, could affect the various features of the disease, the factors that trigger its development and the best treatments. Their hope is that a better understanding of the differences between the diseases we call RA may provide insights that could eventually lead to new ways to treat and, perhaps in some cases, even prevent it.

Seropositive and Seronegative RA

The most recognized differences in RA cases are between seropositive and seronegative disease, according David S. Pisetsky, MD, PhD, professor of medicine and immunology at Duke University School of Medicine in Durham, N.C.

Seropositive means that blood tests show the presence of anti-cyclic citrullinated peptides (anti-CCPs), also called anti-citrullinated protein antibodies (ACPAs). Anti-CCPs are antibodies produced against proteins in the body undergoing a molecular change in structure called citrullination. They are present in approximately 60 to 80 percent of people diagnosed with RA. Studies have found that, for many people, the antibodies precede the development of clinical symptoms by 5 to 10 years. If you have symptoms consistent with RA and a positive test for the antibody, an RA diagnosis is almost a certainty.

Previously, seropositivity was defined in terms of an antibody called rheumatoid factor (RF). Rheumatoid factor is an antibody directed to sites on other antibodies and can be detected by a variety of tests. While most patients with anti-CCP antibodies are also positive for rheumatoid factor, the RF antibody can occur in patients with many other conditions, including infection. Anti-CCP is more specific for RA and is becoming the preferred test for making this distinction.

Seronegative means that tests don t show the presence of these antibodies in your blood. You can have RA without being seropositive, but it is easier to meet the criteria if you are positive, says Dr. Pisetsky.

Aside from the presence or lack of antibodies, there are a few other differences in people with seropositive and seronegative RA. For one, people with seropositive, or anti-CCP-positive, disease have a common sequence of amino acids called the shared epitope. This shared amino acid sequence is encoded in the human leukocyte antigen (HLA) genetic site, or locus, which produces proteins that control immune responses. It is not known how the amino acid sequence contributes to RA, but it has been proposed that it attaches to parts of proteins called citrullinated peptides, and therefore contributes to the production of anti-CCP antibodies. Interestingly, smoking is strongly related to the development of RA in patients with the shared epitope. Scientists believe that smoking causes inflammation in the lung, which leads to protein citrullination which in turns induces anti-CCP antibodies in genetically susceptible people with the shared epitope.

Other differences have to do with the risk factors associated with seropositive and seronegative disease.

While one might predict that anti-CCP-negative RA would be milder disease, that isn t always the case. And although it is unlikely that a person with seronegative RA will ever turn positive, it is possible for people with seronegative disease to eventually be diagnosed with a different disease altogether, Dr. Pisetsky says.

Dr. Pisetsky gives these examples:

  • A person diagnosed with seronegative RA may eventually develop a skin rash that would cause the doctor to change the diagnosis to psoriatic arthritis.
  • Joint fluid tests in what appears to be RA could lead to a diagnosis of chronic gout.
  • Osteoarthritis can sometimes be confused with seronegative RA.

A Common Clinical Endpoint

Some researchers contend that RA is not a separate and distinct disease, but rather represents a common clinical endpoint for various starting points, each of which is guided by as yet poorly understood aspects of the genetic background of the affected individual, says John D. Carter, MD, associate professor, chief of the division of rheumatology and director of clinical research at the University of South Florida in Tampa.

Depending on the trigger and the individual s genetic makeup you get different manifestations of what we call RA, and these different presentations are lumped into one diagnosis, he says.

In addition to the shared epitope associated with seropositive disease, genetic makeup may account for other differences such as extraarticular manifestations (beyond the joints) including lung or eye involvement or rheumatoid nodules, Dr. Carter says. Researchers are looking for genetic differences in individuals with RA that may explain variances as disease severity, manifestations, triggers and treatment responses that may have significant consequences for future research and the development of new therapeutic interventions.

This obviously could be tremendously important when it comes to treatment, as a predictor of response, says Dr. Carter. Many are now looking for biomarkers to predict response. I believe this feeds into the same theory. A different biomarker signature probably exists for each different type of what we now call RA.

Updated april 2015

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14/08/2017

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Are We There Yet? 10 Travel Activities for Kids #airline #travel

#travel games for kids
#

Everything in this slideshow

Steven Vote

Mark the Miles

Before starting out on their first major expedition (an 18-hour drive to Florida from their home in Springfield, Ohio) with their 2-year-old and 4-year old, the Larsons hung little numbered tickets above each boy’s car seat, one for every hour of the trip. “They were redeemed for wrapped treats they could play with or eat along the journey,” says mom Therese. “They loved pulling down the ticket when I asked in my conductor voice: ‘Tickets, please!'”

Easy Travel Toys

-Pipe cleaners (shape them into toys and sculptures)

-Aluminum foil (ditto)

-Uninflated balloons (to blow up and bat around at airports and rest stops)

-Glow-in-the-dark toys (when traveling at night)

Packing Tips

-Simplify hotel stops by packing everyone’s overnight gear in one bag.

-Pack a bedtime car kit for days that run late, with jammies, toothbrushes, and blankets for each child.

-Use resealable plastic bags to separate outfits, stash swim gear, and store laundry before washing.

-Print a packing list for each child and put it in her suitcase so that she can use it to pack for the trip home.

-Bring a collapsible cooler to fill with snacks and lunches on day trips.

Originally published in the June/July 2012 issue of FamilyFun magazine.





01/08/2017

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Getting There – The Scilly Isles #bath #travel

#isles of scilly travel
#

The Scilly Isles

Getting There

When you travel to the Isles of Scilly. it is not just the destination but the journey which is important. It can be a bit of a trek to get to Scilly, unless you live in Cornwall, but the trip really is part of the holiday experience. This introductory guide takes you through the different transport options available, with details of the different operators, prices and times, and gives you some information about travel on and between the islands once you have arrived.

Getting to the Scilly Isles

In order to get to the Scilly Isles, you will need to get to one of the ports which operates services to St Mary’s and Tresco islands. You can fly from places such as Bristol, Southampton, Exeter, Newquay or Penzance by plane, or take the helicopter from Penzance, or catch the ferry from Penzance.  Once you have arrived at any of these ports, whether by train, car, coach or bus, you can choose between any of the following options to get to the islands:

British International Helicopters  fly from Penzance. This is probably the most spectacular way to arrive, with the turquoise water glistening beneath you, the sun shining overhead and the rocky outcrops of secret islands emerging in the distance. However this option is certainly more expensive, and flights to or from the Scilly Isles may often be cancelled due to bad weather (in which case you will probably be shipped onto the replacement ferry without being refunded the difference).

Unlike the plane and the ferry, you can buy discounted return trips on the helicopter. Singles will cost you ?100 per adult. 65 per child and ?38 for infants. Period returns cost ?190 for adults. 119 for children and ?65 for infants. Saver returns – those at special times – are cheaper at ?162 per adult. 104 per child, and ?62 per infant. Day trip returns cost ?110. 72 and ?52 respectively.

You can get direct or connecting flights to the Scilly Isles from the following locations: Bristol and Newquay (Air South West connections to the Scillies), Penzance, Southampton, Land’s End, Exeter, Aberdeen, Alderney, Cardiff, Birmingham, Edinburgh, Glasgow, Guernsey, Inverness, Jersey, Leeds-Bradford, Isle of Man, London, Manchester, Newcastle, Norwich, Plymouth, Germany, France, Spain, the Netherlands, Switzerland or New York.

Isles of Scilly Travel  runs flights from Southampton, Newquay, Exeter, Bristol and Land’s End to St Mary’s island. The downside of this option is that flights are sometimes cancelled due to bad weather (if this happens you will hopefully board a replacement ferry, but will not be refunded the difference).

Unless you are returning from the Scillies on the same day, then you will have to get two one way fares. The Skybus to or from Land’s End costs ?60 for an adult. 46.50 for a child. 27.50 for an infant, and ?12.50 for a dog. From Newquay it is ?75 per adult. 59 per child, and ?36 per infant. From Exter it is ?100 per adult. 55 for a child, and ?32 for infants. From Bristol it is ?115 per adult. 62.50 for a child, and ?36.50 for infants. Flying from Southampton will cost you ?135 per adult. 79 per child, and ?43.50 per infant.

Alternatively you can take the Scillonian III ferry, a much cheaper but a much more lengthy and less comfortable option. This passenger ferry is run by Isles of Scilly Travel and sails 6 days per week between March and October each year. This is much more reliable than the helicopter and plane, as these may be cancelled due to bad weather, but if you are accustomed to P O ferries or fancy cruise ship liners then you are in for a rude awakening. It may be basic, but it is regular, reliable and it gets you there and back!

Unless you are returning from the Scillies on the same day, then you will have to get two one way fares. The ferry from Penzance costs ?42.50 per adult. 21.50 per child. 11 for infants, and ?12.50 for dogs.

Getting Around the Scilly Isles

Once you arrive at the Scilly Isles, most of your transport will be my mini-bus taxi, bike, boat or on foot. Mobility scooters are also available in some places. You can take day trips to the different islands, in addition to exploring the island where you are staying. Here is a summary of these different options:

Bryher Boats provide regular crossings between the islands from February to November each year: daily between Tresco and Bryher; Monday-Saturday to St Mary’s; Monday, Wednesday and Friday to St Martin’s; Sunday, Tuesday and Thursday to St Agnes; and circular trips around the islands Sunday, Tuesday and Thursday.

St Agnes Boating runs a twice daily service between St Agnes and St Mary’s from April to November, in addition to return trips to Bryher, Tresco and St Martin’s. Return journeys will cost you in the region of ?8-?8.50. Or you can opt for a weekly pass which will cost approximately ?30.

Bicycle hire on St Mary’s with Book a Bike is priced at ?12 per day or ?60 per week, and you can cycle round the whole island in just a few hours. St Mary’s Bicycle Hire charges ?10 per day or ?50 per week. You can also hire bikes on Tresco through the Tresco Estate, which again charges ?10 per day or ?50 per week.

These last around 1 hour 10 minutes and cost ?8 per person, allowing you to see all of St Mary’s island in no time at all. This options is perfect for some – including day trippers – who want a convenient way to see everything. The tours are operated Monday-Saturday, twice per day, by Island Rover .

Thanks for reading about how to travel to the Isles of Scilly. and about the kinds of transport within and between the islands of Scilly. Now that you know how to get there, take a look at the different islands…





04/05/2017

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Are We There Yet? 10 Travel Activities for Kids #travel #bug

#travel games for kids
#

Everything in this slideshow

Steven Vote

Mark the Miles

Before starting out on their first major expedition (an 18-hour drive to Florida from their home in Springfield, Ohio) with their 2-year-old and 4-year old, the Larsons hung little numbered tickets above each boy’s car seat, one for every hour of the trip. “They were redeemed for wrapped treats they could play with or eat along the journey,” says mom Therese. “They loved pulling down the ticket when I asked in my conductor voice: ‘Tickets, please!'”

Easy Travel Toys

-Pipe cleaners (shape them into toys and sculptures)

-Aluminum foil (ditto)

-Uninflated balloons (to blow up and bat around at airports and rest stops)

-Glow-in-the-dark toys (when traveling at night)

Packing Tips

-Simplify hotel stops by packing everyone’s overnight gear in one bag.

-Pack a bedtime car kit for days that run late, with jammies, toothbrushes, and blankets for each child.

-Use resealable plastic bags to separate outfits, stash swim gear, and store laundry before washing.

-Print a packing list for each child and put it in her suitcase so that she can use it to pack for the trip home.

-Bring a collapsible cooler to fill with snacks and lunches on day trips.

Originally published in the June/July 2012 issue of FamilyFun magazine.





30/04/2017

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Getting There – The Scilly Isles #cheap #flight #and #car #rental

#isles of scilly travel
#

The Scilly Isles

Getting There

When you travel to the Isles of Scilly. it is not just the destination but the journey which is important. It can be a bit of a trek to get to Scilly, unless you live in Cornwall, but the trip really is part of the holiday experience. This introductory guide takes you through the different transport options available, with details of the different operators, prices and times, and gives you some information about travel on and between the islands once you have arrived.

Getting to the Scilly Isles

In order to get to the Scilly Isles, you will need to get to one of the ports which operates services to St Mary’s and Tresco islands. You can fly from places such as Bristol, Southampton, Exeter, Newquay or Penzance by plane, or take the helicopter from Penzance, or catch the ferry from Penzance.  Once you have arrived at any of these ports, whether by train, car, coach or bus, you can choose between any of the following options to get to the islands:

British International Helicopters  fly from Penzance. This is probably the most spectacular way to arrive, with the turquoise water glistening beneath you, the sun shining overhead and the rocky outcrops of secret islands emerging in the distance. However this option is certainly more expensive, and flights to or from the Scilly Isles may often be cancelled due to bad weather (in which case you will probably be shipped onto the replacement ferry without being refunded the difference).

Unlike the plane and the ferry, you can buy discounted return trips on the helicopter. Singles will cost you ?100 per adult. 65 per child and ?38 for infants. Period returns cost ?190 for adults. 119 for children and ?65 for infants. Saver returns – those at special times – are cheaper at ?162 per adult. 104 per child, and ?62 per infant. Day trip returns cost ?110. 72 and ?52 respectively.

You can get direct or connecting flights to the Scilly Isles from the following locations: Bristol and Newquay (Air South West connections to the Scillies), Penzance, Southampton, Land’s End, Exeter, Aberdeen, Alderney, Cardiff, Birmingham, Edinburgh, Glasgow, Guernsey, Inverness, Jersey, Leeds-Bradford, Isle of Man, London, Manchester, Newcastle, Norwich, Plymouth, Germany, France, Spain, the Netherlands, Switzerland or New York.

Isles of Scilly Travel  runs flights from Southampton, Newquay, Exeter, Bristol and Land’s End to St Mary’s island. The downside of this option is that flights are sometimes cancelled due to bad weather (if this happens you will hopefully board a replacement ferry, but will not be refunded the difference).

Unless you are returning from the Scillies on the same day, then you will have to get two one way fares. The Skybus to or from Land’s End costs ?60 for an adult. 46.50 for a child. 27.50 for an infant, and ?12.50 for a dog. From Newquay it is ?75 per adult. 59 per child, and ?36 per infant. From Exter it is ?100 per adult. 55 for a child, and ?32 for infants. From Bristol it is ?115 per adult. 62.50 for a child, and ?36.50 for infants. Flying from Southampton will cost you ?135 per adult. 79 per child, and ?43.50 per infant.

Alternatively you can take the Scillonian III ferry, a much cheaper but a much more lengthy and less comfortable option. This passenger ferry is run by Isles of Scilly Travel and sails 6 days per week between March and October each year. This is much more reliable than the helicopter and plane, as these may be cancelled due to bad weather, but if you are accustomed to P O ferries or fancy cruise ship liners then you are in for a rude awakening. It may be basic, but it is regular, reliable and it gets you there and back!

Unless you are returning from the Scillies on the same day, then you will have to get two one way fares. The ferry from Penzance costs ?42.50 per adult. 21.50 per child. 11 for infants, and ?12.50 for dogs.

Getting Around the Scilly Isles

Once you arrive at the Scilly Isles, most of your transport will be my mini-bus taxi, bike, boat or on foot. Mobility scooters are also available in some places. You can take day trips to the different islands, in addition to exploring the island where you are staying. Here is a summary of these different options:

Bryher Boats provide regular crossings between the islands from February to November each year: daily between Tresco and Bryher; Monday-Saturday to St Mary’s; Monday, Wednesday and Friday to St Martin’s; Sunday, Tuesday and Thursday to St Agnes; and circular trips around the islands Sunday, Tuesday and Thursday.

St Agnes Boating runs a twice daily service between St Agnes and St Mary’s from April to November, in addition to return trips to Bryher, Tresco and St Martin’s. Return journeys will cost you in the region of ?8-?8.50. Or you can opt for a weekly pass which will cost approximately ?30.

Bicycle hire on St Mary’s with Book a Bike is priced at ?12 per day or ?60 per week, and you can cycle round the whole island in just a few hours. St Mary’s Bicycle Hire charges ?10 per day or ?50 per week. You can also hire bikes on Tresco through the Tresco Estate, which again charges ?10 per day or ?50 per week.

These last around 1 hour 10 minutes and cost ?8 per person, allowing you to see all of St Mary’s island in no time at all. This options is perfect for some – including day trippers – who want a convenient way to see everything. The tours are operated Monday-Saturday, twice per day, by Island Rover .

Thanks for reading about how to travel to the Isles of Scilly. and about the kinds of transport within and between the islands of Scilly. Now that you know how to get there, take a look at the different islands…





23/03/2017

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